Table 3

Diverging from established dietary guidelines

Reference NoInterview excerpt
3.01 I was all the time feeling quite defensive, because of guidelines, because of what Diabetes UK was saying, because of what cardiologists were saying, because of what Public Health England’s Eatwell Guide is saying. But […] I had a sort of moral obligation to tell [patients] what I knew. I suppose I tiptoed at first. I said [to patients] ‘well you’ll find what the guidance is on the Public Health England website [but] this is another way you could try’. (GP04)
3.02 They don’t get it initially: [they say] ‘I’ve been told brown rice is good for the last 20 years’. (HC08)
3.03 I can confidently say ‘it’s weird, but actually increasing the amount of fat you eat, reducing the carbs, doesn’t put your cholesterol up, it actually reduces it, […] it’s not the fat that makes you fat (which is the intuitive thing that I believed for decades); it’s the carbs that make you fat’. (GP14)
3.04 It’s usually not too hard a conversation, because I usually say ‘has it worked?’ And it never has! Kind of an easy-in really, if they want to explore something different. (GP17)
3.05 It’s very hard to eat addictive things in moderation […] the idea [promoted by food manufacturers and diet companies] that you can have these nice things that you don’t want to give up, and it will work—that’s a lie. (GP12)
3.06 You know, there’s always going to be patients who’s going to struggle—my patients where their depression just dictates everything. If they’re motivated and on top of things, they’re doing really well. And then they’ll spectacularly fall off the wagon and, because we’ve stopped some medications, you know, that sort of safety net’s gone. (GP17)
3.07 I tell them that they can contact me any time […] I’ll say ‘try it for two weeks, see what happens and we’ll discuss it‘. (PN15)
3.08 It just helps that I’m their GP and I know them really well. […] I have to have a lot of individual conversations about exactly what are people doing. (GP17)
3.09 I’m a bit reluctant to send them to [a diabetes education course), there are things about general diabetes that I think they need to learn, but [I say] ‘just bear in mind what I’m telling you today might be completely different to what you learn in there. (PN15)
3.10 In the last year I’ve avoided referring people to the dieticians, because they’re going to tell them the exact opposite of what I’m telling them. (GP17)
3.11 [The low-carb approach] really changed [lifestyle] conversations for me, especially learning a lot about the food industry, really taking away the blame from the patients, and shifting away from this ‘eat less, move more’ mantra that just doesn’t work for people. (GP17)
3.12 Healthcare systems are breaking, financially I can’t refer a child for a mental health support because we have no money, and yet we can throw money away on a reversible problem. It just, it’s wrong in every way, and yet there’s a relatively simple solution. (GP06)